NEW YORK (Reuters Health) – The patency of saphenous veins used for coronary artery bypass grafting is better in the 3 months after the operation when patients are treated with aspirin and clopidogrel rather than aspirin alone, a Beijing team has shown.

In their report in the November 9 issue of the Journal of the American College of Cardiology, Dr. Shengshou Hu and colleagues note the high rate of venous graft occlusion after CABG, and that antiplatelet therapy with aspirin and/or clopidogrel reduces ischemic events in patients with cardiovascular disease. “To date, however, no trial has prospectively evaluated the synergistic effects of aspirin plus clopidogrel on saphenous vein graft disease after CABG.”

To investigate, the researchers, at the Chinese Academy of Medical Sciences & Peking Union Medical College, randomly assigned 249 consecutive CABG patients to receive aspirin 100 mg/d plus clopidogrel 75 mg/d or aspirin 100 mg/d alone as soon as “clinical stability was ensured and chest tube output was <30 mL/h for at least 2 h.” At 3 months postop, 224 of the patients under CT angiography. This showed graft patency was 91.6% in the aspirin + clopidogrel group compared with 85.7% in the aspirin-only group. On multivariate analysis, dual antiplatelet therapy almost doubled the likelihood of the graft patency (relative risk 1.996, p=0.045), according to the report. However, there was no significant difference between groups in terms of major adverse cardiac events (ie, cardiogenic death, MI, or need for revascularization), probably because of the moderate sample size and short follow-up. Dr. Hu and colleagues conclude, “Longer follow-up and larger sample size might be warranted to reveal the effectiveness of dual antiplatelet therapy on the end point of clinical outcome.” Reference:
Aspirin Plus Clopidogrel Therapy Increases Early Venous Graft Patency After Coronary Artery Bypass Surgery: A Single-Center, Randomized, Controlled Trial

J Am Coll Cardiol 2010;56:1639-1643.